IntroductionSarcopenia is a chronic condition that is associated with aging and characterized by a reduction of muscle mass, strength, and function. Sarcopenia is prevalent in patients with chronic kidney disease (CKD) and associated with increased morbidity and mortality, as well as cardiovascular complications.ObjectivesTo investigate the prevalence of sarcopenia in patients with CKD not yet on dialysis and its correlation with clinical and laboratory variables and inflammatory markers.MethodsA total of 100 patients of both sexes aged over 18 were evaluated. Sarcopenia was defined using the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) and of the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project. Sociodemographic and clinical data, activities of daily living, functional capacity, and physical activity were also evaluated. Inflammation was assessed by the serum levels of high-sensitivity C-reactive protein (hsCRP) and interleukin (IL) 4 and 6.ResultsThe prevalence of sarcopenia was 11.9% and 28.7% using the EWGSOP and FNIH criteria, respectively. Sarcopenia was more prevalent in the more advanced stages of CKD (34.5% in stages 2 and 3A; and 65.5% in stages 3B, 4, and 5) and associated with worse performance in activities of daily living (p = 0.049), lower walking speeds (p < 0.001), and higher body mass indexes (BMIs) (p = 0.001) in the non-adjusted model. In addition, patients with sarcopenia had lower functional capacity (p = 0.012) and higher prevalence of physical inactivity (p = 0.041) compared with patients without sarcopenia. After adjustment for confounding variables, sarcopenia was still significantly correlated with walking speed (p = 0.004) and BMI (p = 0.002). HsCRP levels were inversely correlated with appendicular lean mass adjusted for BMI (p = 0.007) and were also positively associated with BMI (p = 0.001). IL4 levels were positively correlated with walking speed (p = 0.007) and lean mass in the lower limbs (p = 0.022).ConclusionsSarcopenia is common in patients with CKD, particularly in the most advanced stages of the disease. We observed an association between the levels of inflammatory markers and peripheral lean body mass, physical performance, and BMI. This association between sarcopenia and modifiable factors highlights the importance of early diagnosis and the implementation of therapeutic measures to minimize adverse outcomes in patients with CKD not yet on dialysis.

Chronic kidney disease (CKD) alters the morphology and function of skeletal muscles, thereby decreasing patient physical capacity (PC) and quality of life (QoL). Intradialytic resistance training (IRT) is a pragmatic tool used to attenuate these complications. However, IRT has not been strongly adopted in nephrology care centers. This study aimed to assess the efficacy and safety of a low-cost, easy-to-use IRT protocol. Methods: The study enrolled 43 patients (52.8 ± 13.85 years) on HD for five to 300 months followed from April 2014 to July 2017. The efficacy of IRT was assessed based on PC - derived from muscle strength (MS) and preferred walking speed (PWS) - and QoL. The occurrence of adverse events was used as a measure of safety. The IRT protocol consisted of exercises of moderate to high intensity for the main muscle groups performed three times a week. Results: The mean follow-up time was 9.3 ± 3.24 months, for a total of 4,374 sessions of IRT. Compliance to the protocol was 96.5 ± 2.90%, and patients presented significant improvements in MS (from 27.3 ± 11.58 Kgf to 34.8 ± 10.77 Kgf) and PWS (from 0.99 ± 0.29 m/s to 1.26 ± 0.22 m/s). Physical and emotional components of QoL also increased significantly. Conclusion: IRT led to significant increases in PC and higher scores in all domains of QoL. Important adverse events were not observed during intradialytic resistance training.

Objective: to verify the association between frailty and the occurrence of falls, hospitalization and death among Brazilian elderly persons. Methods: a representative sample of elderly persons from the city of Juiz de Fora, Minas Gerais, Brazil, who had been evaluated with regard to frailty, socio-demographic conditions and health in 2009, were reevaluated in terms of negative health outcomes between 2014 and 2015 (n=304). Results: The results revealed a greater incidence of falls, hospitalization, and death among frail elderly persons. The frail group also had an increased risk (1.5, crude estimate) of death during the follow-up period than the robust individuals. The pre-frail elderly had a 55% (crude) and 58% (adjusted) greater risk of falls, and an 89% (crude) greater risk of death than robust individuals. Conclusion: frailty, as well as pre-frailty, can increase the risk of adverse events in the health of the elderly.

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Background: Frailty has been associated with lifestyle, chronic diseases, and genetic alterations and with high levels of proinflammatory proteins, justifying the relationship proposed by the emerging literature that seeks associations between frailty and cardiovascular diseases. Objective: To investigate clinical and sociodemographic factors associated with frailty, emphasizing the relationship with peripheral arterial disease. Methods: Medical records of 76 patients were analyzed, considering the results of the ankle-brachial index test, fragility, sociodemographic and clinical variables. After the descriptive analysis, differences between groups were tested by chi-square test, student’s t-test and Tukey's post hoc test, when they were appropriated. The value of p < 0.05 for statistically significant differences was considered. Results: The prevalence of frailty in the study sample was 22.3%, and 47.3% for pre-frail. Frailty was associated with female gender, hypertension, dyslipidemia and level of education. Changes in ankle-brachial index test were statistically associated with frailty. Conclusion: The results of this research show the necessary targeted efforts to prevent and treat frailty.Keywords: peripheral arterial disease, cardiovascular disease, chronic disease, fragility.

Objective: This study aimed to investigate the effects of moderate- to high-intensity intradialytic progressive resistance training (IPRT) on muscle strength (MS), physical capacity (PC), and quality of life (QoL) in end-stage renal disease patients. Methods: Twenty-seven sedentary hemodialysis patients (55.5±10.6 years) were divided into a resistance training group (RTG, n=15) and a control group (CG, n=12). Patients of RTG were submitted to IPRT, three times per week for 12 weeks. The Borg’s scale was used for exercise prescription.  Muscle strength was measured using hand grip dynamometry (MS). The sit-to-stand (STS) test and usual walking speed (UWS) test were performed to measure the physical capacity, and the SF-36 questionnaire to evaluate the quality of life (QoL). All patients were evaluated at baseline and after 12 weeks. Results: Moderate- to high-intensity IPRT significantly increased the MS (p=0.001, effect size (ES)=0.98), the physical capacity evaluated by the STS (p=0.002, ES=0.85) and UWS (p=0.014, ES=1.11), and all domains of SF-36 questionnaire (p<0.05). On the other hand, in the CG these variables did not change significantly. The protocol was well tolerated and was not associated with significant clinical complications. Conclusion: Twelve weeks of moderate- to high-intensity IPRT in HD patients was safe and improved MS, PC, and QoL.

O envelhecimento populacional bem como suas características vem ganhando destaque na literatura científica nacional contudo, é notória a necessidade de maior aprofundamento sobre o quadro clínico, as consequências fisiológicas, os eventos negativos associados à senescência e as limitações associadas a este processo além do elevado risco para eventos adversos à saúde característicos da Fragilidade. Assim, o presente estudo tem por característica se tratar de uma revisão narrativa de literatura que busca destacar tais consequências e sugerir meios econômicos e eficazes de diagnóstico e intervenção para tal tanto na atenção primária quanto secundária a saúde.